OP0181 MORTALITY IN POLYMYALGIA RHEUMATICA: A 35-YEAR PROSPECTIVE OBSERVATIONAL STUDY FROM SOUTHERN NORWAY.
Authors: S. Tengesdal, G. Myklebust
Journal: Annals of the Rheumatic Diseases (2022)

Background Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease in the elderly characterized by proximal muscular pain and stiffness. Although PMR is associated with systemic inflammation, prolonged glucocorticoid therapy and probably cardiovascular diseases, previous studies have not shown increased mortality. However, the number of studies is limited. Objectives The aim of this study was to determine whether PMR is associated with increased mortality in a large PMR cohort followed prospectively for a period of 35 years. Methods All patients diagnosed with PMR according to the criteria of Bird between 1987 and 1997 in the county of Aust-Agder, Southern Norway, were identified. Further details about the inclusion process have been published previously [1]. Patients in the prospective part of this study were followed until death or December 31, 2021. Standard mortality ratios (SMR) were calculated using population data (age- and gender-matched) from Statistics Norway as reference. Difference in survival between men and women was estimated using the Kaplan-Meier method. The study was approved by the regional ethics committee. Results A total of 296 patients were included. Among these were 200 (67.6%) females, and the mean age at diagnosis was 71.9 (SD 8.4). The vast majority, 277 patients (93.6%), were deceased at the censoring date of December 31, 2021. Mean observation time for all patients was 13.8 years (95% CI 12.8-14.7). The overall SMR was 1.05 (95% CI 0.93-1.18), for females 1.14 (95% CI 0.99-1.31) and for men 0.91 (95% CI 0.73-1.11). SMRs and mean survival times are presented in Table 1. The Kaplan-Meier survival curve showed no pronounced difference in survival between men and women (Figure 1). Table 1. Standard Mortality Ratios. n Person-years Observed Expected SMR 95% CI Mean survival time 95% CI All patients 296 4079 277 263.18 1.05 0.93-1.18 85.7 84.9-86.5 - Male 96 1326 89 98.04 0.91 0.73-1.11 85.0 83.5-86.4 - Female 200 2752 188 165.14 1.14 0.99-1.31 86.0 85.0-87.0 Age at diagnosis &lt;60 31 678 21 17.16 1.24 0.78-1.84 78.6 78.0-81.3 60-69 91 1626 84 83.14 1.01 0.81-1.25 83.8 82.2-85.4 70-79 123 1394 121 118.39 1.03 0.85-1.22 86.8 85.7-87.9 ≥80 51 380 51 50.64 1.00 0.76-1.31 90.7 89.5-91.8 Men 2 years 185 9 8.29 1.09 0.53-1.99 5 years 436 17 21.03 0.81 0.49-1.27 10 years 788 36 43.67 0.82 0.59-1.13 25 years 1272 83 88.57 0.94 0.75-1.16 Women 2 years 392 11 12.76 0.86 0.45-1.50 5 years 934 32 35.80 0.89 0.62-1.25 10 years 1678 68 74.03 0.92 0.72-1.16 25 years 2687 172 156.21 1.10 0.95-1.28 “Years”: refer to calculated survival time from date of diagnosis; “Observed”: number of deaths in the PMR cohort; “Expected”: number of expected deaths in age-matched, sex-matched, and year-matched background Norwegian Population. Figure 1. Kaplan-Meier survival curve. Conclusion To our knowledge, this is the first prospective study following a large PMR cohort from diagnosis to death. In women, overall mortality (SMR) was increased compared to the general Norwegian population. This tendency to increased mortality in women was observed during the last decades of the study period. Furthermore, increased SMR was observed in patients aged &lt;60 at time of diagnosis and in men the first 2 years after diagnosis, although with wide confidence intervals due to the limited number of deaths in these subsets. References [1]Gran JT et al. Survival in polymyalgia rheumatica and temporal arteritis: a study of 398 cases and matched population controls. Rheumatology. 2001; 40: 1238-42. Disclosure of Interests None declared